1,043 research outputs found

    The Ayllus of the Chanka Heartland: An Interdisciplinary Assessment

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    This article discusses Chanka kinship and social organization in the light of settlement pattern studies, bioarchaeology, and the need for defense

    The effectiveness of cognitive analytic therapy for borderline personality disorder : utilizing a withdrawal experimental design to improve sensitivity to abandonment

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    Objectives A primary methodological weakness of the single‐case experimental design (SCED) outcome studies conducted of the treatment of personality disorder with cognitive analytic therapy (CAT) is that they have failed to employ a withdrawal phase or cross‐over design and so are deemed quasi‐experimental. This study sought to implement a withdrawal design, in order to improve the internal validity of the study to make it a true SCED, and also in order to enable the patient to explore abandonment dynamics. Design The study employed an A1/B1/A2/B2 with extended follow‐up SCED with a female patient treated with CAT meeting diagnostic criteria for borderline personality disorder (BPD). Following the 6‐week baseline period ‘A1’, treatment occurred in two phases (21 sessions ‘B1’ and 24 sessions ‘B2’) sandwiching a 12‐week treatment withdrawal phase (‘A2’) and a 24‐week structured follow‐up phase. Seven idiographic daily measures were collected that created a N = 698 day timeline. Nomothetic outcome measures were collected at baseline and at the end of each phase of the study, and the Session Impact Scale was completed after each treatment session. Results There was a significant increase in the task focus of treatment sessions. Ideographically, CAT was an effective treatment for improving the participant’s self‐to‐self relationship, as their self‐hate reduced and their sense‐of‐self increased. There was a broad pattern of deterioration during the second treatment phase (B2) and follow‐up phase across the ideographic measures, and CAT was ineffective for BPD ideographic emotional or self‐to‐other measures. Reliable change occurred on the primary BPD nomothetic outcome measure from baseline to end of first treatment phase. Conclusions The study suggests that the CAT intervention was partially successful and that it is possible to integrate good research practice with clinical innovation. The methodological strengths and limitations of the design and the clinical implications of the results are discussed. Practitioner points Cognitive analytic therapy was partially effective in the treatment of BPD in a case that had been unresponsive to other psychological interventions. Therapists need to complete lengthy and structured follow‐up to capture any emerging relapse. Therapists need to discuss the patient’s thoughts and feelings about termination regularly in a relationally informed manner

    Assessment of Identity Disturbance: Factor Structure and Validation of the Personality Structure Questionnaire in an Italian Sample

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    here are few brief measures of identity disturbance for use in clinical practice that have been subject to any cross - culturally validation . This study investigated the construct validity of the Personality Structure Questionnaire (PSQ) in Italian clinical (N=237) and community ( N=296) samples . Confirmatory factor analysis was conducted to investigate the internal structure of the PSQ. A three – factor structure (i.e., differing self - states, mood variability and behavioral loss of control) including a second - order factor provided the best fit to the data . This structure was demonstrated to be invariant across sex and clinical diagnosis , with clinical diagnosis significantly predicting increased PSQ scores . A g lobal PSQ score of between 26 - 28 was found to be an appropriate cut-off for assisting in diagnostic processes. Implications for the assessment and treatment of psychological disorders with a marked identity disturbance component are discussed

    Day-case surgery for total hip and knee replacement: how safe and effective is it?

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    Multimodal protocols for pain control, blood loss management and thromboprophylaxis have been shown to benefit patients by being more effective and as safe (fewer iatrogenic complications) as conventional protocols. Proper patient selection and education, multimodal protocols and a well-defined clinical pathway are all key for successful day-case arthroplasty. By potentially being more effective, cheaper than and as safe as inpatient arthroplasty, day-case arthroplasty might be beneficial for patients and healthcare systems

    The Diagnostic Potential of Transition Region Lines under-going Transient Ionization in Dynamic Events

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    We discuss the diagnostic potential of high cadence ultraviolet spectral data when transient ionization is considered. For this we use high cadence UV spectra taken during the impulsive phase of a solar flares (observed with instruments on-board the Solar Maximum Mission) which showed excellent correspondence with hard X-ray pulses. The ionization fraction of the transition region ion O V and in particular the contribution function for the O V 1371A line are computed within the Atomic Data and Analysis Structure, which is a collection of fundamental and derived atomic data and codes which manipulate them. Due to transient ionization, the O V 1371A line is enhanced in the first fraction of a second with the peak in the line contribution function occurring initially at a higher electron temperature than in ionization equilibrium. The rise time and enhancement factor depend mostly on the electron density. The fractional increase in the O V 1371A emissivity due to transient ionization can reach a factor of 2--4 and can explain the fast response in the line flux of transition regions ions during the impulsive phase of flares solely as a result of transient ionization. This technique can be used to diagnostic the electron temperature and density of solar flares observed with the forth-coming Interface Region Imaging Spectrograph.Comment: 18 pages, 6 figure

    Exploring infrastructure provision issues in greenfield and urban infill residential developments

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    Australia is a highly urbanised country. Planning policy in most Australian cities is trying to divert development that would naturally have occurred on the urban fringe into inner established areas. A large part of the argument for this policy is that State and Local governments are challenged to provide appropriate standards of infrastructure and services in greenfield locations. This paper explores the extent of infrastructure provision issues and tries to identify the actual costs of provision in different situations. Three case studies in metropolitan Adelaide were chosen to explore the cost factors for developers and government. One case study is in the greenfield development within the Playford Alive project on the northern urban fringe; the second is within the renewal area of Playford Alive; and the third is the transit oriented development in Bowden, adjacent the Adelaide Park Lands. While some costs are able to be determined from a review of budget documents and annual reports of State and Local government agencies, the study has found it somewhat difficult to arrive at any firm conclusions about relative costs of infrastructure provision. The estimated costs for infrastructure for the infill development at Bowden are approximately one third that of both greenfield and renewal areas of the Playford Alive project. In established areas, the increased density of development implies a policy review of the capacity of existing infrastructure. In addition, there is concern about standards for streetscapes and transport infrastructure required to meet multiple objectives such as high quality urban design and active/healthy living.Cathryn Hamilton and Jon Kellet

    The acceptability, effectiveness, and durability of cognitive analytic therapy : Systematic review and meta‐analysis

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    Objectives This paper sought to conduct a meta‐analysis of the effectiveness and durability of cognitive analytic therapy (CAT) and assess the acceptability of CAT in terms of dropout rates. Design Systematic review and meta‐analysis. Methods PROSPERO registration: CRD42018086009. Searches identified CAT treatment outcome studies eligible to be narratively synthesized. Pre–post/post‐follow‐up effect sizes (ESs) were extracted and synthesized in a random‐effects meta‐analysis. Variations in effect sizes were explored using moderator analyses. Dropout rates were extracted. Secondary analyses synthesized between‐group ES from trials of CAT. Results Twenty‐five studies providing pre–post CAT treatment outcomes were aggregated across three outcome comparisons of functioning, depression, and interpersonal problems. CAT produced large pre–post improvements in global functioning (ES = 0.86; 95% CI 0.71–1.01, N = 628), moderate‐to‐large improvements in interpersonal problems (ES = 0.74, 95% CI 0.51–0.97, N = 460), and large reductions in depression symptoms (ES = 1.05, 95% CI 0.80–1.29, N = 586). All these effects were maintained or improved upon at follow‐up. Limited moderators of CAT treatment effect were identified. CAT demonstrated small–moderate, significant post‐treatment benefits compared to comparators in nine clinical trials (ES = 0.36–0.53; N = 352). The average dropout rate for CAT was 16% (range 0–33%). Conclusions Patients with a range of presenting problems appear to experience durable improvements in their difficulties after undergoing CAT. Recommendations are provided to guide the further progression of the CAT outcome evidence base